FMR 27 messages by promoting awareness of SGBV and the availability of PEP among its own national staff, patients and other local organisations. Where rape victims seek care outside conventional health structures, with midwives or traditional birth attendants (TBAs), MSF is starting to liaise more closely with them. TBAs can tell victims about the availability of PEP and refer SGBV cases to MSF health structures. In Sudan, MSF is considering employing qualified TBAs as community health workers, both to better reach out to rape victims and to encourage TBAs to liaise with MSF facilities without fear of losing income from their own patients. comprehensive approach – providing medical care within a framework including IEC, psychosocial support, legal assistance and liaison with other women’s organisations who can provide continued material and social support. In contexts without acute problems of violence, MSF employs a horizontal approach. SGBV is part of all our healthcare programmes globally – over 35 projects worldwide. The challenge for horizontal programmes is that SGBV becomes just one issue of many faced by medical staff in their hectic day’s work. The impact of stigmatisation makes it all the more difficult for SGBV to be handled in a general medical structure. One way that MSF counters this problem is by establishing ‘safe spaces’ in every health structure, where women can speak about their health questions and about SGBV with the assurance of full privacy and confidentiality. MSF would ideally like to open separate women’s clinics in all its projects, if availability of female medical staff allows it.

SEXUAL VIOLENCE
As MSF’s main expertise is medical, both horizontal and vertical approaches rely heavily on the presence of others who can assume responsibility for psychosocial, legal and material/economic follow-up. Due to the complexities inherent in these